Structured 3-month non-invasive telemonitoring in heart failure: impact on mortality and hospitalisation in a matched cohort study
A Drohomirecka, P Wanczura, D Trzmielak, A Bielecka-Dabrowa, K Wita, M Wisniowski, L Raciborski, E Chudzynska, B Pedzinski, A Zapasnik, P Zuk, R Mlynarski, T RywikAbstract
Background/Introduction
Structured follow-up supported by remote monitoring should improve the quality of care in heart failure (HF); nonetheless, the prognostic impact of a given care model requires evaluation.
Purpose
To assess all-cause mortality and survival free from HF hospitalisation in patients enrolled in a 3-month pilot of non-invasive vital-sign telemonitoring supported by telecare, compared with a matched population control cohort.
Methods
This multi-centre non-randomised comparative cohort study was conducted within a structured 3-month pilot programme of non-invasive vital-sign telemonitoring supported by multidisciplinary telecare involving cardiologists, general practitioners and nurses. Outcomes were assessed over approximately 2 years of follow-up. Controls were derived from a national payer database and matched 1:10 using demographic and clinical variables via exact matching supplemented by propensity score matching when required.
Results
A total of 1,346 programme participants (562 women; 917 aged ≥65 years) were analysed for survival and matched to 13,447 controls.
Participation in the telemonitoring-plus-telecare programme was associated with lower all-cause mortality (HR 0.40, 95% CI 0.32–0.50, p < 0.001), while time to first HF hospitalisation did not differ (HR 0.99, 95% CI 0.866–1.12, p = 0.83).
Across multivariable models (see the tables), female sex was associated with lower risk of both death and HF hospitalisation, whereas increasing age was associated with higher mortality but not with HF hospitalisation. Comorbidities and ischemic aetiology of HF were consistently associated with worse prognosis for both endpoints, and residence outside large cities was linked with worse outcomes.
Conclusions
Although the programme did not reduce HF hospitalisations, it was associated with lower all-cause mortality. Notably, this survival benefit persisted over long-term follow-up despite telemonitoring being limited to 3 months, suggesting that telecare-supported monitoring established an early-response approach to decompensation with faster treatment of HF worsening.Cox regression analysesKaplan–Meier curves